In this March 23, 2010, file photo, President Barack Obama reaches for a pen to sign the health care bill in the East Room of the White House in Washington. Obama's re-election has guaranteed the survival of his health care law. Now the administration is in a sprint to the finish line to put it into place. In just 11 months, millions of uninsured people can start signing up for coverage. But there are hurdles in the way. Republican governors will have to decide whether they can join the team and help carry out what they've dismissed as "Obamacare." And the administration could stumble under the sheer strain of implementing the complex legislation, or get tripped up in budget talks with Congress.

Bay Area consumers could see health insurance rates rise by more than 20 percent under proposals being considered by state lawmakers to carry out the new federal health legislation, according to the state Insurance Department.

The federal health law requires most Americans to have health insurance by Jan. 1, 2014, and many people will be purchasing coverage through state- or federal-run insurance exchanges, or virtual marketplaces.

The law, often referred to as Obamacare, will prohibit health insurers from rejecting or charging consumers more based on their medical histories. Charging more based on age will be limited so older consumers cannot pay more than three times what a younger person would pay.

But geography is still fair game.

The state Legislature this week is holding its first hearings in Sacramento as part of a special session on the bills that provide the state framework for the federal health reform. Lawmakers are not expected to make any final decisions for several weeks.

On Wednesday, Senate and Assembly health committees will consider various proposals to slice and dice the state into a number of regions and allow insurers to charge different rates in those areas. Health insurers currently create their own regions for rate-setting purposes, and the proposed changes could cause some rates to rise from their current levels.

Under a plan proposed by health committee leaders, the state could be divided into six regions: a Bay Area region; a "northern" group of counties starting with Monterey; the Central Valley; the southern coast including Santa Barbara and Ventura counties; Los Angeles County; and the southernmost parts of the state.

But other ideas are on the table. The state's insurance exchange, which has been named Covered California, has proposed a 19-region system and the Department of Insurance recommended an 18-region plan.

Insurance Commissioner Dave Jones argued the Bay Area could see the highest increases in the state under a six-region plan because the area is dominated by large, expensive hospital systems.

"What those bills do is reduce the number of overall regions and change the boundaries of those regions in such a way that some individuals in the Bay Area will be hit with up to 23 percent rate increases," Jones said. He said consumers in any one region would not see increases higher than 8 percent under his proposal.

"There are many people doing different analyses," said Pan, who is also a pediatrician. "While we'll be working with many other people to be sure we get this thing right, most importantly we do need to get this bill passed."

Health advocates agreed that legislators are racing the clock to get everything in place to start selling insurance in October for coverage beginning in 2014. But they want the regions to be fair.

"We want to prevent even the possibility of redlining," said Anthony Wright, executive director of Health Access.